Examination of Witnesses (Questions 20
- 39)
MONDAY 19 NOVEMBER 2001
MR NIGEL
CRISP AND
MR DAVID
FILLINGHAM
20. Which they object to, do they not?
(Mr Crisp) Well, the negotiations are going all right
at the moment actually.
21. That is good. They threatened to strike
about three months ago, did they not?
(Mr Crisp) I think you are thinking about the GPs,
I am talking about the consultants at the moment. The consultant
contract renegotiation is looking at issues such as productivity
and workload and also issues such as—
22. Tell us about the private work they do.
(Mr Crisp)—private work and exclusivity to the
NHS.
23. How much private work can they do in their
contracts? How much are they allowed to do?
(Mr Crisp) It depends on whether or not you are a
full-time consultant or a maximum part-time consultant. If you
are a full-time consultant, you are allowed to do an amount which
should not add up to more than 10 per cent of your salary, but
you can also be a part-time consultant, at which point you are
entitled to do more private work.
24. So every consultant who is on a full-time
contract can do 10 per cent private work?
(Mr Crisp) That is my understanding.
25. How many consultants are there in the country?
(Mr Crisp) There are somewhere between 17,000 and
20,000.
26. Exactly. That just about answers the question,
does it not? If they did full National Health Service work instead
of private work, how many more operations could be done a year
in the National Health Service?
(Mr Crisp) I have never attempted to do that calculation.
27. I bet you have not.
(Mr Crisp) I would just make the point that if people
were not doing some operations in the private sector, those operations
would have to be done in the NHS.
28. But they might have to wait their turn?
(Mr Crisp) That may be the case. This is not a simple
adding and subtracting issue.
29. I accept that. How much private work is
done in National Health Service hospitals?
(Mr Crisp) Again, I am sorry, I will have to give
you a note on that, I do not know the answer.
30. How many National Health Service beds are
used for private care?
(Mr Crisp) Again, I do not know that answer.[1]
31. Shall I tell you? I knew this meeting was
coming up so I asked a Parliamentary Question last week and I
asked the number of admissions from non-National Health Service
hospitals into National Health Service trusts, and last year alone,
1999-2000, there were almost 7,000 beds taken up by private operations
in the Health Service. That does not seem to be right to me.
(Mr Crisp) If you looked at the same set of figures,
you will also see the NHS had actually reduced in the last year
the number of private patients it treated.
32. It did, by about 200 or 300?
(Mr Crisp) Yes.
33. It also increased from 1996-97 though.
(Mr Crisp) There is an element in which the NHS is
providing service to private patients and there will be a number
of private patients who would rather use the NHS for a whole series
of reasons, including they are dealing with some of the most—
34. I am not against private medicine, if people
want to pay, that is up to them, but what I do object to is them
using the National Health Service hospitals and creating longer
waiting lists.
(Mr Crisp) But the argument about allowing it within
the NHS has three or four prongs to it, and one of the important
things is it does actually produce some additional revenue into
the hospital which then provides for more beds. So you will find
that if there were 7,000 beds—and I have to say I do not
recognise that figure—private patients are paying more than
those 7,000 beds and contributing to the bigger pot.
35. I do not think that answers the question.
(Mr Crisp) That is one argument for it. There are
other arguments for it as well, including it is important for
many hospital managers to have their consultants doing their private
practice actually within the hospital, because that actually supports
the hospital as well. So there are some good arguments for having
a mixed economy.
36. I do not want to get bogged down in this
so I will move on. Figure 5 on page 11 shows us the inpatient
waiting list is falling, the number of operations is going up,
and that sounds great and so it is, so why is it then that some
people do have to still wait 18 months?
(Mr Crisp) We do not want it to happen. These figures
here say that 70 per cent of people are admitted within three
months.
37. That is not the question though.
(Mr Crisp) That is where we are building from. To
get everybody else admitted within six months, which is where
we are aiming to be by the end of—
38. But you are missing the question. I want
to know why people have to wait 18 months. I cannot understand
why they have to wait 18 months. If there are more operations
and the lists are coming down, why is somebody having to wait
18 months?
(Mr Crisp) Year on year it is moving in the right
direction, but it will take some time because this is a very,
very big organisation, these are huge numbers of people. We have
some estimates of the further increases in activity we need to
get our waiting lists down, so we can bring everybody in.
39. It is still not answering the question though,
why do they have to wait 18 months?
(Mr Crisp) I am sorry, I am being obtuse here as to
what the answer is. Clearly, we need to put more resources into
the system, we need to put more money, more capacity and more
staff into the system, all those things are happening but they
take time to build up.
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